Tumor Tip of the Week-Pericolonic/Pericolorectal tissue Invaded-Reg or Local

#1 Scenario: 2022 pT3 pN0 cM0 Stage IIA Transverse Colon with Extension through the wall into pericolic tissue, 16 nodes (-), no mets on CT.

Question: How would you code Summary Stage 2018?

Answer: 2 Regional by direct extension only

Summary Stage 2018– READ THE NOTES!!!!!

Note 6: Invasion into “pericolonic/pericolorectal tissue” can be either Localized or Regional,

depending on the primary site. Some sites are entirely peritonealized; some sites are only

partially peritonealized or have no peritoneum. Localized may not be used for sites that are

entirely peritonealized (cecum, transverse colon, sigmoid colon, rectosigmoid colon, upper third

of rectum).

Invasion through muscularis propria or muscularis, NOS
Non-peritonealized pericolic/perirectal tissues invaded [Ascending Colon/Descending Colon/Hepatic Flexure/Splenic Flexure/Upper two thirds of rectum: Posterior surface; Lower third of rectum]
Subserosal tissue/(sub)serosal fat invaded
Regional
- Mesentery
- Peritonealized pericolic/perirectal tissues invaded [Ascending Colon/Descending Colon/Hepatic Flexure/Splenic Flexure/Upper third of rectum: anterior and lateral surfaces; Cecum; Sigmoid Colon; Transverse Colon; Rectosigmoid; Rectum: middle third anterior surface]
- Pericolic/Perirectal fat
If the pathologist does not further describe the “pericolic/perirectal tissues” as either “non-peritonealized pericolic/perirectal tissues” vs “peritonealized pericolic/perirectal

tissues” fat and the gross description does not describe the tumor relation to the

serosa/peritoneal surface, and it cannot be determined whether the tumor arises in a

peritonealized portion of the colon, code Localized.

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#2 Scenario: 2022 pT3 pN0 cM0 Stage IIA Ascending Colon with Extension through the wall into pericolic tissue, 16 nodes (-), no mets on CT.

Question: How would you code Summary Stage 2018?

Answer: 1 Localized only (localized, NOS)

Summary Stage 2018- READ THE NOTES!!!!!

Note 6: Invasion into “pericolonic/pericolorectal tissue” can be either Localized or Regional,

depending on the primary site. Some sites are entirely peritonealized; some sites are only

partially peritonealized or have no peritoneum. Localized may not be used for sites that are

entirely peritonealized (cecum, transverse colon, sigmoid colon, rectosigmoid colon, upper third

of rectum).

Invasion through muscularis propria or muscularis, NOS
Non-peritonealized pericolic/perirectal tissues invaded [Ascending Colon/Descending Colon/Hepatic Flexure/Splenic Flexure/Upper two thirds of rectum: Posterior surface; Lower third of rectum]
Subserosal tissue/(sub)serosal fat invaded
Regional

Mesentery
Peritonealized pericolic/perirectal tissues invaded [Ascending Colon/Descending Colon/Hepatic Flexure/Splenic Flexure/Upper third of rectum: anterior and lateral surfaces; Cecum; Sigmoid Colon; Transverse Colon; Rectosigmoid; Rectum: middle third anterior surface]
Pericolic/Perirectal fat
If the pathologist does not further describe the “pericolic/perirectal tissues” as either “non-peritonealized pericolic/perirectal tissues” vs “peritonealized pericolic/perirectal tissues” fat and the gross description does not describe the tumor relation to the serosa/peritoneal surface, and it cannot be determined whether the tumor arises in a peritonealized portion of the colon, code Localized.

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